HomeMy WebLinkAbout20800-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Uffice of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22024 Date DECEMBER 14, 1992
THIS CERTIFIES that the building NEW DWELLING
Location of Property 275 APPLE COURT SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 1 Lot 6.,4'1
Subdivision SOUTHOLD VILLAS Filed Map No. Lot No. 11
conforms substantially to the Application for Building Permit heretofore
filed in this office dated July 2, 1992 pursuant to which
Building Permit No. 20800-Z dated JULY 9, 1992
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING (1st FLOOR ONLY) AS APPLIED FOR
The certificate is issued to PECONIC PROPERTIES MANAGEMENT INC.
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-48-NOV. 17, 1992
UNDERWRITERS CERTIFICATE N0. N-258832 - DECEMBER 2, 1992
PLUMBERS CERTIFICATION DATED OCT. 8, 1992 - ARTHUR LALAAUSSENA Jr.
ing Inspector
Rev. 1/81
IfOltl[ N0. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°N° 208002 gate ............~j.......9 19.3.~t.-
Permission is hereby gra~ to: ~,,,.-y1.:
J~r,...Dc...l.!.~. v:~
.............................................Yy.....
..~~!!`.!l!A~kti~L~...q....!!Y11..~ uu
to ..~.ra...
of premises located at ...w7.,Z `.vu~...../..W..:~:.(1.~ ~..1.............
.
County Tex Map No. 1000 Section .....Q1~......... Block Lot No. Q ~
pursuant to application doted 19.4.3.,E and approved by the
Building Inspector.
Fee 5..,.~1:.~..
np Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOSdN HALL
765-1802 ( ~i~~
APPLICATION FOR CERTII'ICATE OF OCCUPANCY , . '
A. This application must be filled in by typewriter OP, ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2, A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4.. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ,,,,Povember 18:.1992••.....••........•..
New Construction........... Old Onr..P,re-existing Building
Location of Property.. ~.~:~.....rn:y~~L,,.~,Q'1~,,,,,,,,,,,,,,,,,,,SOOTHOLD, NEW YORK•...•...
House No. +v Street Hamlet
Onwer or Owners of Property...........,PECONIC.PEOPEETIES•MANAGEMENT INC:.
.
County Tax Map No 1000, Section.....7.Q......Block...~............Lot....~T:~
Subdivision.,li(O.SOiJTHOLD,VILI.AS,,,,,,,,...•,,,piled Map.. 9737 .....Lot..
Permit No..~Q`5.~~„',-,,,,,Date Of Permit..:~Y,9,,1992 „Applicant.,DONALD.BRACREN•••,,,,,,•...
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Fin Certicate...........
Fee Submitted: 25•~~
e ~ oCo2O 2y APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1.000R3I BUREAU OF ELECTRICITY
83 JOHN STREET. NEW YORK. NEW YORK 10038
Date DECEt(RER 02,1992 APPlicarionNo.onfila 78705892/92. N 258832
THIS CERTIFIES THAT
only the electrical equipment as described bebra and introduced by the oppficont named on [he obove opplicotion number in thepremiua of
HRf,ONAER SOUTHOLD VILLAS, 275 APFLE COURT, J08t11, SOUTNOLD, N.Y.
in thefolloEVinq locotion: ®Basement ?X let FL ®2nd F'1. OUT .Section B/ock Lot
uws examined on NOVBNBER "[5,1992 andfound to be in compliance u•ifh the requirements q(thia Buard.
FlX7URE ECEPTACLES SWI7CME5 FlXTURES RANGES COOKING DECKS VENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCEm fIVOREECENi OTHER AMi. K.W. AMT. K. W. AMi. K.W. AMi. K.W. AMi. X.P.
i 23 1!i 7
DRYERS RIRNACE MOTORS WTURE APPLIANCE RFDERS SPECIALRK'?T 71ME CLOCKS BELL UNIT HEATERS MULTI.OUTIET DIMMERS `
AMi. K. w. at N. v. GAS H. P. AMT. NO. A. W. G. AM}. AMP. AMT. AMPS. TRANS. AMT. H. P. SYSTEMS AMT. WATLa 1i
NO.OF RET
5lRVICE DISCONNECT NO.Oi S B R V 1 C E
AMT. AMR. TYPE METER 1 / tW 1 ,e 3W ~ H JW 3/ AW NG. OF CC COND. A. W G. NO. Of MLIEG A' W' G. NO. Of NEViRAIa A. W 4 !F
FOUIP. PER b OF CC.COND. Of HbIEG Of NEVTRAI
1 100 CR 1 X 1 4 1 4
OTHER APPARATUS:
f{OTOR311-P N.N.
G.F.i'.II-2
SfIOKr; DETECTOR i - 1
f
c
SPUDS BLECTRIC SERVTCF LIC,{192 E
/
175 3RD. ST. AOX 166
TEREIIRAt MANAGER
ST. JANE5, NY, 11''80 11
Per
i This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
j D N BE ALTERED IN ANY MANNER.
5~FF0(l~-~, TEL. 765-1802
o~~ -v. TORN OF SOtiJTIIOd.D
c f ~ ` r • < OFFICE OF BUILDIP7G INSPECTOR
~ m P.O. BOX 1179
.c??~~~ T0IVNHALL
%Ol ~ ~b0 SOUTHULD, N.Y. ] 1971
C E R T I F I C A T I O N
Date ~ 9~
Huildirg Permit No. Q L
Owner
(please print)
Plumber 1/~/,Q ~gS~~~
(please print)
Czb 3/-P~
I certify that the solder used in the water supply system
contains less than 2/10 of 1, lead.
(plumber's signature)
Sworn to before me this
day of .
19~, '
otary Public
Notary Public, r~~~Count
Y
MARYANNE E. DOWLING
Notary Public, State of New York
No. 5000030
Qualifietl in Suffolk County
Commission Expires August 3, 199' . -
ao8oo
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [4~ ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
Qa FRAMING [ ]FINAL
REMARKS: D-iC ~o
DATE ~ O 1' 9 INSPECTOR V G'
~og~~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [ ]ROUGH PLBG.
[)FOUNDATION 2ND INSULATION
[ ]FRAMING [)FINAL
REMARKS: ~ ~'v ~
DATE 1 ~ ~ L, INSPECTOR
ac'8Do
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [o~ FINAL
REMARKS: ~ ~ S.. o
DATE ~ , ~ IN8PECTOR Y~-
i I.=LJ iGS: -~.:J:i jlUn:j jl ii14i9ENT^
1 . _ ~ • m O
Qd'
y d
'OUt]DATI07J (1st) _
'OU7JDATZ071 (2nd) I y
- - m
;OUGn[7(FRki•fE I ~J
Vi
•P INC
•
IU ti
H
:77SULATI0;1 PER Y, Y, I y
STATE E7IERGY I~ (~j
CODE I ~ , -
H
I
FZ;1AL I - 1
. i 4 0
ADDITIOPIAL COMMENTS:
7 17 f2
D
-
nom' ~ P
m
x
~ . .i
H ~
C.. a a o
'i
o ,o
. -
> ~ ~ "O
r ~
7
p ~ ~ p
[+7 ~
^v
. -i ~C.
• ~ ~ ~ ~ a1
• BOARD OF HEALTH
FORMNO.1 ~ SETS OF PLAt7S
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CIIECt: • • • • • • • • • • • • • -
TOWN HALL SEPTIC FORtI
SOUTHOLD, N.Y. 11971 L/
TEL.: 765-1802 t:oTIFYI h6 ~ 6~ l ~
~~~~,,,,1111 CALL J
Examined qQ,,,~ 19QZ. !TAIL T0:
Approved l.., 19~.1Permit No..3.0?~tTy ~i. • . .
Disapproved a/c •
-
n
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date d 19 .~c;
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing ,code, and regulatioris, and to
admit authorized inspectors on premises and in building for nece s mspect'on ~
(Signature of applicant, or ha e, if a corporation)
~./i~s..~. ~!9.~:~...
(Mailing ads of appli(dant)
State whether applicant i~s owne/r,/lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
?
Name of er of premises .C.P:fi,N,~G. ~/LG~d~~~~:~'. ~T~:'/-!p-°' ~4~+-~.~~-G,
(as on the to roll or latest deed)
[f a I' is a o gfatior signature of duly authorized officer.
i V,
wine and title of corporate officer)
Builder's License No . .
Plumber's License No. ....~.R ~ ~...P....... .
/c%
Electrician's License No. 1 .
Other Trade's License No . .
I. Location of land on w/~hich proposed work will be done. ..er~~!-:r!(z~;~~~,~~~fl,Q, , , ,/~~{tir/6+~
.H
house Number hStreet Hamlet l
County Tax Map No. 1000 Section J. Block ~ Lot ....Q .
r --J / .
Subdivision .(<J'~K1 L~e:~'~. I~G`cZi-' Filed Map No. . ~ ~,J Lot . .
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
! , .
b. Intended use and oceu anc ~ ~.~[~.,t.~x~' t~-f'
3. Nature of work (check which applicable): New Building . Addition Alteration .
Repair Removal Demolition Other Work .
(Description)
4. Estimated Cost Fee......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
• If garage, number of cars .
6. If business, commercial or mixed occupancy, specify nature and extent of each t
YPeofuse
7. Dimensions of existing structures, if any: Front Rear Depth .
Height Number of Stories .
Dimensions of same structure with alterations or additions: Front Rear .
Depth Height ......................Number of Stories .
imensions of entire new construction: Front Rear De th
p
Height Number of Stories .
9. Size of lot: Front Rear Depth
ate of Purchase ..Name of Former Owner
..Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation : .
13. Will lot be regraded ............................Will excess fill be removed from premises: Yes No
14. Name of Owner of premises ....................Address ...................Phone No............... .
Name of Architect ...........................Address ...................Phone No............... .
Name of Contractor ..........................Address , Ph44~~ No............... .
15. Is this property within 300 feet of a tidal wetland? *yes,,,,,,,. No../.~.....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YQRK S.S
COUNT )Y~O~F ...../S.:~ ~
• • • • (--t~~/•/Q.L-• • • •~/<•~~if'~ ~/Y being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
Notary Public, s~l
County
_
ROBERT t. SCOTT,
NOTARY PUBLIC, Sta of N.Y. (Signature of applicant)
No. 4)15089, SuffoNc
Term Expires May 31,19
Nips,
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3:12 4
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ti ~
~ 94 0/'
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\ \ f.1 SEMEVA T~oN S'3~/20°~. ^1~/
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5. \ay.
3J,
~ PLEASE NOTE
W s` s stem ~s not to be
b_ pja~
under driveway area.
- .
y5~
39"O z9 y3.
'X30. 5'
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LAS
~,r-e~-~~ ~y~~~~'~ASM~~ EXPIRES N3~ Y V •DWEtl.iN6pN .y.`
~ a ~ y3 FROM DA7E OFA~ROVAI.
G~~-~-U-~- , ii 93s--
SURVEY OF
~~=15,000~~ LOT 11
o~ sourwav vrcas"
Prepared In accordance w11h the minlmum u~~P
standards /or !qle survsys os established 14 T SOUTHOLD
by the L.I.A.L.S and appproved and odop/ed TOWN OF SOUTHOLD
for such use by The Nsw York Slate Land
rnie Associolion. SUFFOLK COUNTY, N. Y.
The water supp/y and sewage dlsposol 1000 - 70 - 01- P/0 OB
systems for Jhls residence w1p con/arm ~
fo the standards o1 The Sullo/k County SC8/@~ ~ = 3~
D rlmenl 01 Heollh Services. March 19.9?
O'i/~/'c-C1.P~Qvi/
The /ocallons of wells and cesspools shown hereon oie /ram lleld
observol/ons and or /ram data obtained tram others.
S t~' a ~D ~ eO r~ LAND SG
~a, rrcr, y ~r 9
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES "'x ~9~t[fm~r ~'r ~ _ ~ °24, L~
FOR APPROVAL OF CONSTRUCTION ONLY ,J'~ ~ ~,dr„ , J;,~ F9 O
70 N. Y.S. L/C. N0. 496/8
DA S. REF. NO. ~ ^ MAY ~g 199p ~ ~ ORS, P.C.
.Q
$
APPROVED HfALTE~
fR~ OF
!l SOUTH D, N. Y. 1/97/
87-670 /l
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~ 4cr~~
ti ¢
a `DNS
B,~ SFIVf-,`,q ~,~ON s,3y2~~
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l 39
~,z9 55~~.
e(2 Z6*
~ ti~ ~
P~ G~ ~k
I J cERr~aev ra
ThE Lt7M1i6 /SLAhD SAV11YB6 BAN~C
I PECONC PROiERTES AtAAbI~NT CORP.
I
~k ~
~ ~~p8
9
s
~a
a
't SURVEY Of
~ LOT 11
~xaP o~sourHatv,vcus'
Prepared An accordance wlhl hb mJn~hxwn a®'~'~~' ~
sJandaralc for ,wl. swwys as eslaiNsMd A T SC~t/TMOrLD
by hYe L.I.d.L.~ awd gqooprav.s and a~p/ed TO ~ ~ S~T~D '
lar sueh use by TM Naw York Slob Card y
T1Ne AuociaAbn. ~Vr"/"V6I1 VV~Nr / I ~ ~ I.
The wo/er supply and swoye a+sposa/ aDGO - 7iD - Of - P/O OQ
rys/e~mc kr !h/s residence w~fl cowlorm
Jo a,. sla~adards Th. sL//ouMr wanly SCii~: 1" = 3p'
Deparhnen/ o! Weallh Services. ~
Y J5, 1~9Z (fotndati~
The /ocoHons o/ wells and csaspooh; shown hsiso~n are /rom lle/d
observoHons and or /rom dolo oblaJned /rom olMrs.
su~a.?c cDUiTr DElART1iNT of FIEALTH SERVICES . G~~.r
z ~y
?oR Arvltov,LL of ccBeraucran atr mss.
~ N.Y.S. LIC. NO. 49618
DATE "Q REF. NO.
ORS, P.C.
o,
~ ~ F
SO , N. Y. 1/9Tl
87-670 /J
• N/p~
'94,0/•
a `oNS qN
\ FwSF~~NTT~oN s.~,~,/2pog A~gMI/
b X3.00.
v
~ S .
M 3~ I
~ i- SUFFOLK COUNTY" DEPARTMENT QF H(~LTi+ ERVICES
ae ° SINGLE fi;M10.1LY L1'seELLiI#C, l,LY
b S
h ti e ~ ti~ `a_~ 0 6p~V
1~7 10~fiS. i±E NU.~~
~ w ~ ~ ~ sR. ~ ~ Thg anw~aa ~s~i~aal aid ~a~ r , i~p i f ` 'hj5
~ o Iocalion h v. ba,r i~~ + c, ;ytr , ~~~r~en~ a~,d/or
1-~
~ ~ ~ ~ ® other agei~ci s antt„(ouna [o be satista~~tory.
2 obi i,
~ Chief of eeu of Wastewa4er M~gement
9°s ~ .c~5
<.392~, / 5y3
QQv~ ~
P G~
J
CERTAFAED TOE
ThE LANG /BLAND SJIVNVGS BAMK
PECAN~C PROPERTES AIANUGEAIENT CORP.
moo. G~ iri3 ~/~ii9.~
I {r~aq
w.,~
io.oo'
LAS
JAS~~
SURVEY OF
~ LOT 11
o~ ~ vuAS"
F[EV.~,~~ ~92~MO.92s~
Pnpored /n occordance w/hl the mInlmum
slondaras /or lgle .surveys os eslabOsl?sd A T SOUTHOLD
by 1M L.A.e.L.S and roved and odop/ed TOWN OF SOUTHOLD
for such use by Ths New York S/a/e Land SUFFOLK COUNTY, N. Y.
TI1M Associol/on.
Ths wo/er supp/y aid s+ewags d/spoaol ' 70 ' D~ - P~0 ~
systems /or 1h/s res/dencs wlp con/orm
l0 /M s/ardards of The Sullolk County SCa/9~ = 30~
Deporlma?1 0l Health Services. March 11, 1992
J~[ Y 15, 1892 (far/dationJ
The locallons of wells and cesspools shown hereon are lrom lleld OCt. 23
obssrvallons and or lrom do/a obtained lrom others. fN~IJ
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ~jg{q~}`
FOfi APPROVAL OF CONSTRUCTION ONLY ii 4l
92 $O 48 `i(/ ~ ;i'Vr •S. LIC. N0. 496/8
DATE 4S. REF. NO. NOY I3 199Z PE t?~ B. , P. C.
P. O. '
APPROVED S.C. KEPT. OF RO
HEALTH SESVlCES SOUTHOLD, N. Y. l/97/
' 87-670 /l